How to differentiate between acute epididymitis and testicular torsion, which are similar

Acute epididymitis and testicular torsion can be distinguished through medical history, physical examination, and auxiliary examinations. Both require emergency treatment to prevent testicular function damage.

1. Pain characteristics

The pain of acute epididymitis usually worsens gradually. The initial manifestation is a feeling of swelling in the scrotum, which develops into persistent pain within a few days, which may be accompanied by discomfort during urination. Testicular torsion results in sudden severe pain, which is common during strenuous exercise or sleep. The pain reaches its peak immediately and often radiates to the groin area. Testicular elevation during physical examination may reduce pain in patients with epididymitis, whereas elevation in patients with torsion may worsen symptoms.

2. Characteristics of scrotal enlargement

Patients with epididymitis often have redness and elevated skin temperature on the scrotal skin. The epididymis is obviously swollen and tender on palpation, and the testicular position is usually normal. In patients with testicular torsion, the entire testicle is elevated in a transverse position, the spermatic cord may become thickened and twisted, and the cremasteric reflex disappears. The testicles may not be swollen at the beginning of the disease, but will become uniformly swollen due to ischemia over time.

3. Differences in accompanying symptoms

Acute epididymitis is often accompanied by urinary tract infection symptoms such as frequent urination and urgency, and some patients may have systemic reactions such as fever. Patients with testicular torsion rarely experience urinary system symptoms, but may be accompanied by vagal excitement symptoms such as nausea and vomiting. There are no abnormalities in the spermatic cord during palpation of the spermatic cord in patients with epididymitis, but torsion nodules may be palpable in patients with torsion.

4. Ultrasound examination performance

Color Doppler ultrasonography is an important means of identification. Epididymitis manifests as epididymal blood flow signal enhancement and volume increase, and testicular blood flow is normal or slightly increased. In the early stage of testicular torsion, the testicular blood flow completely or partially disappears, and in the later stage, the echo of the testicular parenchyma is uneven. Ultrasound examination requires bilateral comparison, paying attention to the relative position of the testicles and epididymis.

5. Laboratory indicators

The blood routine of patients with epididymitis often shows elevated white blood cells and neutrophils, and the urine routine shows pyuria or bacteriuria. Inflammatory indicators in patients with testicular torsion may be normal in the early stage, and urine routine is usually normal. When torsion is clinically suspected but sonographically inconclusive, markers of testicular ischemia such as serum lactate dehydrogenase can be tested.

If you find a scrotal emergency, you should seek medical treatment immediately and avoid strenuous exercise or local heat compresses. It is necessary to keep the perineum clean every day and avoid holding in urine or sitting for long periods of time. Wear loose underwear to reduce compression, and a scrotal sling can be temporarily used in the acute stage. If there are recurrent urinary tract infections, it is recommended to check whether there are underlying diseases such as urinary tract malformations. If you experience sudden severe scrotal pain that does not subside for more than 2 hours, you must go to the emergency department immediately.